Electrical neural stimulation (ENS)

Policy context

Electrical Neural Stimulation (ENS) is an electroanalgesia, used to relieve low back pain, myofascial and arthritic pain, sympathetically mediated pain, bladder incontinence, neurogenic pain, visceral pain, and postsurgical pain. Concerns about the efficacy and relative cost of use of ENS, particularly whether the use of ENS units in strategies for addressing chronic pain improve clinical outcomes compared to alternative strategies. There have been many reports concerning the use of ENS for various types of conditions; but ongoing debate about the degree to which ENS is more effective than placebo in reducing pain. Additionally, a variety of newer transcutaneous or percutaneous electrical stimulation modalities recently has emerged.

Status: Decision completed

Primary criteria ranking

  • Safety = Low
  • Efficacy = High
  • Cost = Low
Documents

Assessment timeline

  • Draft report published: September 8, 2009
  • Public comment period: September 8 to 22, 2009
  • Final report published: October 2, 2009
  • HTCC public meeting: October 30, 2009

Background

Electrical Neural Stimulation (ENS) is an electroanalgesia, used to relieve low back pain, myofascial and arthritic pain, sympathetically mediated pain, bladder incontinence, neurogenic pain, visceral pain, and postsurgical pain. A variety of electrical stimulation modalities have emerged including: Transcutaneous electrical nerve stimulation (TENS); Interferential Current Therapy (IFC) to deliver higher currents to larger areas; and Percutaneous Electrical Nerve Stimulation (PENS) which uses electroaccupuncture.

An ENS unit consists of one or more electrical signal generators, a battery and a set of electrodes. The units are small and programmable, and the generators can deliver trains of stimuli with variable current strengths, pulse rates and pulse widths. A variety of transcutaneous and percutaneous electrical stimulation modalities recently has emerged. Some include the wearing of the units for several days at a time, including: Interferential Current Therapy (IFC) to deliver higher currents to larger areas; and Percutaneous Electrical Nerve Stimulation (PENS) which combines advantages of both electroacupuncture and TENS. The proposed mechanism of action is that it causes nociceptive inhibition to reduce or eliminate pain sensation.